title: A conditioning platform based on fludarabine, busulfan, and 2 days of rabbit antithymocyte globulin results in promising results in patients undergoing allogeneic transplantation from both matched and mismatched unrelated donor.
abstract: Conditioning regimen including fludarabine, intravenous busulfan (Bx), and 5 mg/kg total dose of rabbit antithymocyte globulin (r-ATG) (FBx-ATG) results in low incidence of graft-versus-host disease (GVHD) and non-relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (Allo-HSCT) from HLA-matched related or unrelated donors (MUD). However, whether this platform produces similar results in the setting of one mismatch unrelated donor (MMUD) Allo-HSCT is not known. We retrospectively analyzed patients aged less than 65 years who were diagnosed with hematological malignancies and received FBx-ATG regimen prior to Allo-HSCT from MUD (N = 74) or MMUD (N = 40). We compared outcome of MUD versus MMUD patients. There was no difference in the cumulative incidence of grades II-IV acute GVHD (MUD: 34% vs. MMUD: 35%, P = 0.918), but MMUD patients developed more grade III-IV acute GVHD (MUD: 5% vs. MMUD: 15%, P = 0.016). The cumulative incidences of overall chronic GVHD (MUD: 33% vs. MMUD: 22%, P = 0.088) and extensive chronic GVHD (MUD: 20% vs. MMUD: 19%, P = 0.594) were comparable. One-year NRM was similar in both groups (MUD: 16% vs. MMUD: 14%, P = 0.292); similarly, progression-free survival (MUD: 59% vs. MMUD: 55%, P = 0.476) and overall survival (MUD: 63% vs. MMUD: 61%, P = 0.762) were not different between both groups. With a median follow up of 24 months, 35 of 74 MUD patients (47%) and 19 of 40 MMUD patients (48%) were free of both disease progression and immunosuppressive treatment. We conclude that the FBx-ATG regimen results in low incidences of NRM and GVHD in both MUD and the MMUD recipients.
authors.affiliation: Département d'Onco-Hématologie, Institut Paoli-Calmettes, Unité de Transplantation et de Thérapie Cellulaire, F-13273, Marseille, France; Aix-Marseille Université, F-13007, Marseille, France; Inserm UMR1068, Centre de Recherche en Cancérologie de Marseille (CRCM), F-13009, Marseille, France.
authors.forename: Raynier
authors.initials: R
authors.lastname: Devillier
authors.forename: Sabine
authors.initials: S
authors.lastname: Fürst
authors.forename: Roberto
authors.initials: R
authors.lastname: Crocchiolo
authors.forename: Jean
authors.initials: J
authors.lastname: El-Cheikh
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Samia
authors.initials: S
authors.lastname: Harbi
authors.forename: Angela
authors.initials: A
authors.lastname: Granata
authors.forename: Evelyne
authors.initials: E
authors.lastname: D'Incan
authors.forename: Diane
authors.initials: D
authors.lastname: Coso
authors.forename: Christian
authors.initials: C
authors.lastname: Chabannon
authors.forename: Christophe
authors.initials: C
authors.lastname: Picard
authors.forename: Anne
authors.initials: A
authors.lastname: Etienne
authors.forename: Boris
authors.initials: B
authors.lastname: Calmels
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Schiano
authors.forename: Claude
authors.initials: C
authors.lastname: Lemarie
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Stoppa
authors.forename: Reda
authors.initials: R
authors.lastname: Bouabdallah
authors.forename: Norbert
authors.initials: N
authors.lastname: Vey
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
mesh_terms: D000328:Adult; D000367:Age Factors; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002066:Busulfan / Q000008:administration & dosage; D002423:Cause of Death; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine